Authors: Tarik Delko Marko Kraljević Thomas Köstler Lincoln Rothwell Raoul Droeser Silke Potthast Daniel Oertli Urs Zingg
Publish Date: 2015/09/03
Volume: 30, Issue: 6, Pages: 2367-2373
Abstract
Internal hernias IH after laparoscopic RouxenY gastric bypass LRYGB have been reported with an incidence of 11 IH can lead to bowel incarceration and potentially bowel necrosis The aim of this study was to analyze reoperations and intraoperative findings in a cohort of patients with unclosed mesenteric defectsFrom a prospective database of patients with LRYGB we selected as primary cohort patients with nonclosure of mesenteric defects and abdominal reoperation for analysis The data included pre intra and postoperative findings computed tomogram results and laboratory test results This group underwent a very very long limb LRYGB at that time the institutional standard technique Additionally a more recently operated cohort with primary closure of mesenteric defects was also analyzedWe identified 146 patients with primary nonclosure and reoperation mean age of 438 years The main indication for reoperation was unclear abdominal pain in 119 patients with 27 patients undergoing a reoperation for other reasons weight regain prophylactic surgical inspection of mesenteric defects Median time and mean excess weight loss from RYGB to reoperation were 411 months and 627 respectively The incidence of IH was 144 with all patients with an IH being symptomatic Conversion rate from laparoscopic to open surgery was 55 mortality 07 and morbidity 34 Thirtyone patients underwent a second relook laparoscopy Eleven patients had recurrent open mesenteric defects Three hundred and sixteen patients who underwent primary closure of the mesenteric defects had a reoperation rate of 136 and an IH rate of 06 The incidence of IH in patients without closure of mesenteric defects and reoperation is high and substantially higher compared to patients with primary closure of mesenteric defects Patients with or without closure of mesenteric defects following LRYGB with acute chronic or recurrent pain should be referred to a bariatric surgeon for diagnostic laparoscopy
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